Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?
Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?
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DOI：
10.1016/s0140-6736(13)60996-4
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发表时间：
2013-08-03
期刊：
影响因子：
168.9
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Bhutta, Zulfiqar A.;Das, Jai K.;Black, Robert E.
产妇营养不良每年造成80万新生儿死亡，其中包括小于胎龄儿的出生；发育迟缓、消瘦和微量营养素缺乏估计每年导致近310万儿童死亡。自2008年《柳叶刀》关于母婴营养不良的丛书发表以来，随着许多干预措施的大规模实施取得了进展，营养干预措施和提供战略有效的证据越来越多。我们对干预措施进行了全面更新，以解决妇女和儿童营养不良和微量营养素缺乏的问题，并使用标准方法评估新出现的提供平台的新证据。在34个国家中，我们模拟了这些干预措施对挽救的生命和成本的影响，这些国家有全球90%的发育迟缓儿童。我们还审查了利用社区卫生工作者参与贫困人口并促进行为改变、获得和接受干预措施的各种提供平台和提供选择的效果。我们的分析表明，如果人们能够在90%的覆盖率下获得10项循证营养干预措施，目前5岁以下儿童的总死亡人数可以减少15%。此外，获取和摄取加碘盐可以缓解缺碘和改善健康状况。加速增长是可能的，如果以这种方式改善获得机会，使用这些方法可以避免现有发育迟缓负担的大约五分之一。在34个重点国家扩大获得这10项直接营养干预措施所涉及的年度额外总费用估计为每年96亿新台币。继续投资于专门针对营养的干预措施，通过社区参与和能够惠及面临最大风险的贫困人口群体的提供战略，避免孕产妇和儿童营养不良和微量营养素缺乏症，可以产生重大影响。如果将这种改善的机会与对营养问题敏感的办法--即妇女赋权、农业、粮食系统、教育、就业、社会保护和安全网--联系起来，就能大大加快孕产妇和儿童营养不良和死亡率负担最重的国家的进展。
Maternal undernutrition contributes to 800 000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3.1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world's children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9.6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches-ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets-they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.